KELAB PEMILIK ALFA ROMEO MALAYSIA

ALFA ROMEO OWNERS’ CLUB OF MALAYSIA Reg No: 5245/93/sel

c/o 34A, Jalan USJ 10/1B, Taipan Centre, 47620 UEP Subang Jaya, Selangor Darul Ehsan, MALAYSIA

BORANG PERMOHONAN AHLI / MEMBERSHIP APPLICATION FORM

(PPM-001-14-11081993)

BORANG PERMOHONAN AHLI / MEMBERSHIP APPLICATION FORM

Nama / Name *

No. K/P / Identity Card No. *

Jantina / Sex *

Alamat Rumah / Home Address *

Mobile Phone *

Email Address *

Home Tel

Office Tel

RHB Bank Berhad Account Details:

2-14129-0010041-3 (AROC MALAYSIA)

Annual Membership Fee: RM 120.00

Registration Fee: RM 80.00 (Waived)

Total Payable Amount: RM 120.00

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